Jayakumar M, Prabahar M Ram, Fernando Edwin M, Manorajan R, Venkatraman R, Balaraman V
Department of Nephrology, Madras Medical College and Government General Hospital, Chennai, India.
Ren Fail. 2006;28(5):405-10. doi: 10.1080/08860220600689034.
There are little data on the incidence of acute renal failure (ARF) from India due to the absence of central registry. The etiology, course, and outcome of ARF differ in various parts of India. Significant trend changes were reported even within a same center over a period of time.
To find out the epidemiologic trend changes in ARF patients, the authors compared the profile of patients admitted by the Department of Nephrology from 1995-2004 with previously published data from 1987-1991.
Data collected from case records of patients admitted with ARF were systemically analyzed for age, gender, etiology, course, and outcome. A total of 32 variables were collected per person retrospectively. The chi-square test, Fisher's exact test, and student t-test were used as tests of significance (p<0.05 was taken as statistically significant).
A total of 1112 patients were diagnosed to have ARF from 1995-2004. The mean age was 37.08 +/- 3.4 yrs. There were 669 (60.1%) males. Medical, obstetric, and surgical causes accounted for 87.6, 8.9, and 3.4 percent of ARF, respectively. Among the medical causes of ARF, acute diarrheal disease was the most common. Other causes of medical ARF included drugs, glomerulonephritis, sepsis, snake bite, leptospirosis, malaria, and copper sulphate, which accounted for 13.4, 9.3, 8.8, 7.8, 7.5, 4.4, and 4.3 percent, respectively. In comparison with the data from 1987-1991, medical ARF remained the most common cause of ARF, though without any statistical significance (87.6 percent vs 89.5 percent, p>0.32). Though surgical ARF had more than doubled from 1.5 percent from 1987-1991 to 3.4 percent (p<0.01) during the present study, it is much less when compared to similar studies in the literature. Obstetric renal failure more or less remained the same (8.9 percent vs 9 percent, p>0.4). A statistically significant decline was noted in overall as well as individual group mortality. The overall mortality declined from 26.4 percent to 19.6 percent (p<0.02). Regarding the outcome of ARF, 611 patients (54.94 percent) showed a total recovery, a partial recovery was noted in 192 patients (17.26 percent), and 91 patients (8.18 percent) had persistent dialysis-dependent renal failure. The factors noted to occur more frequently in the deceased were high entry serum creatinine (>440 micromol), jaundice, sepsis, oliguria, anemia, hypoalbuminemia, and hospital-acquired ARF. The overall requirement of dialysis was 69.0 percent. Hemodialysis was the most common modality of renal replacement therapy.
ARF in South India differs in some important aspects when compared with data from other parts of the country. Significant trend changes were noted with time even within our center. Acute diarrheal disease was the most common cause of ARF. Leptospiral ARF was on the decline, and drugs, sepsis, and malaria were the emerging ARF causes. The incidence of surgical ARF was on the rise. Despite improvements in antenatal care, obstetric renal failure remained a significant cause of ARF. Hemodialysis became the preferred mode of renal replacement therapy.
由于缺乏中央登记系统，关于印度急性肾衰竭（ARF）发病率的数据很少。ARF的病因、病程及转归在印度不同地区存在差异。即使在同一中心，一段时间内也有显著的趋势变化报道。
为了解ARF患者的流行病学趋势变化，作者将1995 - 2004年肾病科收治患者的资料与此前发表的1987 - 1991年的数据进行了比较。
对收集的ARF住院患者病历资料进行系统分析，内容包括年龄、性别、病因、病程及转归。每人回顾性收集32项变量。采用卡方检验、Fisher精确检验及学生t检验作为显著性检验（p < 0.05为有统计学意义）。
1995 - 2004年共诊断出1112例ARF患者。平均年龄为37.08±3.4岁。男性669例（60.1%）。内科、产科及外科病因分别占ARF的87.6%、8.9%及3.4%。在ARF的内科病因中，急性腹泻病最为常见。内科ARF的其他病因包括药物、肾小球肾炎、败血症、蛇咬伤、钩端螺旋体病、疟疾及硫酸铜，分别占13.4%、9.3%、8.8%、7.8%、7.5%、4.4%及4.3%。与1987 - 1991年的数据相比，内科ARF仍是ARF最常见的病因，尽管无统计学意义（87.6%对89.5%，p > 0.32）。虽然本研究期间外科ARF从1987 - 1991年的1.5%增加了一倍多至3.4%（p < 0.01），但与文献中的类似研究相比仍较少。产科肾衰竭基本保持不变（8.9%对9%，p > 0.4）。总体及各亚组死亡率均有统计学意义的下降。总体死亡率从26.4%降至19.6%（p < 0.02）。关于ARF的转归，611例患者（54.94%）完全康复，192例患者（17.26%）部分康复，91例患者（8.18%）持续依赖透析的肾衰竭。在死亡患者中更常见的因素为入院时血清肌酐高（>440微摩尔）、黄疸、败血症、少尿、贫血、低白蛋白血症及医院获得性ARF。透析总体需求率为69.0%。血液透析是最常见的肾脏替代治疗方式。
与印度其他地区的数据相比，南印度的ARF在一些重要方面存在差异。即使在我们中心，随时间也观察到显著的趋势变化。急性腹泻病是ARF最常见的病因。钩端螺旋体性ARF呈下降趋势，而药物、败血症及疟疾是新出现的ARF病因。外科ARF的发病率在上升。尽管产前护理有所改善，但产科肾衰竭仍是ARF的重要病因。血液透析成为肾脏替代治疗的首选方式。
